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Francine R. Digitally signed by Fraeeme R.
<br />,.••� VIIIVilkeel
<br />7 ® Villareal C ,:.I DATE IMMIDDIYYYV)
<br />�� CERTIFICATE OF LIABILITY INSURANCE I 9/13/2021
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed,
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER -
<br />BOwermaster & Associates
<br />10805 Holder St
<br />Ste 350
<br />CONT C
<br />NAME; Lizette Orozco
<br />PHONE
<br />We, No 714-733-6248 aCNa:
<br />AIL
<br />ADDRESS, lorozco@bowermaster.com
<br />Cypress CA9063O
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Philadelphia Indemnity Insurance
<br />18058
<br />INSURED ILLUFOU-01
<br />Illumination Foundation
<br />1091 N. Batavia Street
<br />INSURER B: Redwood Fire &Casual Insurance
<br />11673
<br />INSURER c: Non roots' Insurance Alliance of California
<br />11384
<br />NSURER D:
<br />Orange CA 92867
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 622568538 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES. DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />WJ2
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD
<br />LIMITS
<br />C
<br />tXCON MERCIAL GENERALUABILITY
<br />CLAIMS -MADE � OCCUR
<br />Y
<br />2021-24712
<br />9/15/2021
<br />9/15/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGETORE TEDPREMISES Ea occurrence
<br />$500,000
<br />MED EXP(Any one person)
<br />$20,000
<br />r Liability
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY❑ jECT LOC
<br />GENERAL AGGREGATE
<br />$3,000,000
<br />GEN'L
<br />X
<br />PRODUCTS -COMPIOP AGO
<br />$3,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />2021-24712
<br />9/1512021
<br />9/15/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANYAUTO
<br />I
<br />OWNED SCHEDULED
<br />AUTOS ONLY AS
<br />-
<br />BODILY INJURY Peraccld
<br />entUTO
<br />( )
<br />-PROPERTY-DAMAGE
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />Per accldent
<br />$
<br />C
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />2021-24712-UMB
<br />9/15/2021
<br />9/15/2022
<br />EACH OCCURRENCE
<br />$7,000,000
<br />AGGREGATE
<br />$7,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS' LIABILITY YIN
<br />ILWC209336
<br />1/1/2021
<br />1/1/2022
<br />X I PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANYPROPRIETOR/PARTNEWEXECUTIVE ❑
<br />OFFICERIMEMBER EXCLUDED4
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1.000.000
<br />A
<br />C
<br />Commercial Cyl, Liability
<br />Improper Sexual Conduct
<br />PHSD1575498
<br />2021-24712
<br />9/15/2021
<br />9/15/2021
<br />9/15/2022
<br />9/15/2022
<br />Agg:$3,000,0WIEach
<br />Agg:$1,000,000IEach
<br />$1,000,000
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be etlached if more space Is required)
<br />Re Location: 3535 W. Commonwealth Ave, Fullerton CA
<br />City of Santa Ana, it's officers, employees, agents, and volunteers are Additional Insured with respects to General Liability per attached endorsement form;
<br />Primary and Non -Contributory wording applies per attached endorsement form.
<br />30-day notice of cancellation is provided per policy provisions. -
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />©1988.2015 ACORD CI
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />c Risk MwlsgYn MEDlvtaturl
<br />REVIEWED& APPROVED BY:
<br />i Risk ManagetDc"t Analyst
<br />a
<br />
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